Provider First Line Business Practice Location Address:
720 DESERT GARDENS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL CENTRO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92243-4416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-831-0437
Provider Business Practice Location Address Fax Number:
619-785-3404
Provider Enumeration Date:
04/11/2025